This annex provides for the protection of the
population from the effects of hazards through the
identification of shelters and provision of mass
care and social services in shelters.

II.

CONCEPT OF OPERATIONS

A.

The North Carolina Department of Human Resources (DHR)
through the North Carolina Division of Social
Services (NCDSS) and the County Department of Social
Services (County DSS) is responsible for shelter and
mass care matters. The American Red Cross (ARC)
through written agreement with the State of North
Carolina and by North
Carolina General Statute 166A, may provide
shelter and mass care to the general population in
designated counties during emergencies or
disasters. The Department of Human Resources will
assure that shelter care is made available to
complement American Red Cross services, and in those
situations in which American Red Cross cannot
provide shelter and mass care.

B.

The Department of Human Resources will support
County Social Services efforts, arrange for shelters
at Department of Human Resources Institutions, and
transfer social services personnel to the affected
area as needed. Department of Human Resources will
work in conjunction with the American Red Cross,
Salvation Army, and volunteer organizations to
provide care for emergency or disaster victims.

C.

The County Department of Social Services will be the
primary coordinator of shelter locations and
operation for the general population with American
Red Cross serving a secondary role. Social Services
will be the primary coordinator and accept full
legal and fiscal responsibility for shelter care
staffing to special population(s).

D.

Public and private providers of institutional care
(medical and residential) remain responsible for
having shelter plans which are approved by local
Department of Social Services and Emergency
Management, and for continued care of their
clientele when in shelter.

III.

ORGANIZATION

A.

The American Red Cross will be the primary agency
responsible for providing shelter and mass care in
Fictitious County. This is understanding and
agreement is detailed in the contained in the
Statement of Understanding between the American Red
Cross and Fictitious County Emergency Management.
Letters of Understanding and/or Agreement with the
Fictitious County School System are on file with the
American Red Cross and the School System and are not
part of this document.

B.

The
Department of Social Services is lead county
agency responsible for developing a comprehensive
shelter program in coordination with Emergency
Management and the American Red Cross. Letters of
understanding with the County Department of Social
Services and the school system (as necessary) will
be part of that program.

C.

The County Department of Social Services remains
responsible for providing shelter management as
follows:

1.

For special needs groups within the general
population;

2.

For the general population where ARC does not
provide shelter and mass care; and

3.

Will be responsible for special medical needs
(special needs population) care.

D.

North Carolina Department of Human Resource works
with local emergency management to assure that all
public and private special needs care providers plan
for shelter and mass care needs of their populations
and that public shelter is provided when necessary
for comprehensive shelter care.

IV.

DIRECTION AND CONTROL

A.

The
American Red Cross is the primary lead agency for
shelter / mass care operations.

B.

Alternately, the County Department of Social
Services will direct and control shelter / mass care
operations in situations or circumstances where or
when the American Red Cross cannot provide such
services.

General population shelter supplies consisting of
appropriate forms, handbooks, and identification
will be provided by the American Red Cross. The
shelter supplies should include, but not be limited
to, shelter registration forms, shelter occupancy
reports, inventory reports and event log
forms. Special needs supplies will be provided by
the appropriate county agency.

B.

The primary communications link between shelters and
the Emergency Operations Centerwill be telephone. Amateur radio
operators and / or emergency services personnel
assigned to the shelters will provide additional
radio support.

C.

Shelters will be stocked with appropriate supplies
in accordance with supporting agencies’ Standard
Operation Guidelines.

D.

Sheltering will follow a non-discrimination policy;
however, shelter assignments may be required for
evacuees with special needs.

Most
Fictitious County residents would qualify
for the general public shelter during a
disaster. Persons with impairments who are
self-sufficient and capable of performing
activities of daily living without
assistance, including self-administering
medications, etc, and certain preexisting
conditions would continue to be sheltered in
general public shelters as in the past. Even
people who are patients in adult care homes,
family care homes, and/or clients of in-home
care should qualify for the general public
shelter.

Special
Medical Needs Definition: Those people
whose physical, emotional/cognitive, and/or
medical conditions are such that they, even
with the help from families or friends,
would not be able to meet their basic needs
during a 72 hour emergency period.

The following medically
stable and/or non-complicated medical
problems may seek entrance to the Special
Medical Needs Shelter. (Also see
Appendix A Shelter Triage Tool)

Foley
Catheter maintenance

Diabetes-stable for monitoring of
insulin administration only

Nasogastric
or Gastrotomy tubes (Home maintenance)

Ostomey

Stable
Oxygen and nebulizer therapies (Must
bring own oxygen)

Dressing
changes (must bring own supplies)

Self care
tracheostomy

Bedridden and wheelchair
bound total care will only be accepted
ONLY if they are accompanied and cared
for by responsible caregiver and DO NOT
REQUIRE A HOSPITAL BED.

Restrictions and Limitations:The
Special Medical Needs Shelter should be
considered an option of last resort intended
to maintain the current health, safety, and
well being of the medically dependent
individuals who are not acutely ill, to the
best extent possible. Special Medical Needs
Shelters are not equipped as a medical care
facility.

Special
Medical Needs Residents are strongly
encouraged to make disaster plans where
possible with available licensed health care
or special home care facilities, relatives,
friends and neighbors or in hotels or other
commercial residential options. There will
be NO doctor, NO acute care
nurses, NO specialty care nurses, and
NO caretakers at the Special Medical
Needs Shelter. The shelter's public health
nurses will be providing general oversight
and low level monitoring and will NOT be available
to provide homecare activities of daily
living or administration of
medications/injections.

The Special
Medical Needs Shelter cannot
accommodate people who need:

I.V.
Chemotherapy

Ventilator Care

Peritoneal Dialysis

Hemo
dialysis

Life
Support Equipment

Hospital
Bed and/or total care

Shelter
Capacity: The Fictitious County Health
Department currently can provide only 1
public health nurse (1 nurse for each of two
12 hour shifts per day) to staff the
shelter.

This effectively
limits the shelter capacity to 25-35 persons
based on "best practices" models. Therefore,
preference will be given to Fictitious
County residents during the admission
process - other
persons may be accepted on a space available
basis.

Pre-registration and Database: Persons
with special needs are strongly urged to
pre-register with the Fictitious County
Department of Social Services or Fictitious
County Emergency Management.
Registration forms
are made available in order to:

determine
the potential population for a Special
Medical Needs Shelter

The
Fictitious County Department of Social
Services will provide shelter and mass care
management to the special needs population
and SUPPORT general population shelters with
personnel. The Director of the Fictitious
County Health Department will provide
SUPPORT services (i.e.: Public Health
Nurses). (See
Appendix C -Flowchart of Authority)

ALERT AND
NOTIFICATION

The
Fictitious County Emergency Management
Coordinator will be notified when a major
emergency situation has occurred or is
imminent. The Emergency Management
Coordinator will then inform county
officials in accordance with the county
procedures outlined in the
Emergency Operations Plan. Fictitious
County Emergency Management will notify all
appropriate agencies to open shelters.

PUBLIC
INFORMATION

The Director of the Department of Social
Services will coordinate the release of all
public information (including information
about shelters and mass care) through the
Emergency Operations Center and the
Public Information Officer (PIO).
Shelter/Mass Care managers and/or workers
are advised not to release information to
the media without coordinating with the
Public Information Officer. Information
about the disaster or emergency should be
given to persons in the shelter or mass care
area, but only after that information has
been cleared for release by the PIO or the
Emergency Operations Center. General
information, already released or cleared for
release by the PIO may be given to any
person at the shelter at any appropriate
time. Information is important to people. If
information has not been released have the
Shelter Manager contact the DSS Director or
the designated representative in the
Emergency Operations Center.

WHAT TO BRING TO
THE SHELTER

Special Medical Needs Shelter
clients are expected to
bring supplies to
last 72 hours (3 Days)
including but not limited to:

ADULT CAREGIVERS TO PROVIDE
24 HR ASSISTANCE.
It is critical and mandatory
that all Special Medical
Needs Shelter clients be
accompanied by an adult who
will stay in the shelter
with them at all times and
must be able to perform or
assist the client to perform
ALL of his/her physical and
medical needs/activities.
These activities include
bathing, dressing, toileting
(or diaper changes), eating,
ambulation and taking
medications. The client will
not be allowed to stay in
the shelter if they do not
have an adult with them that
is able to meet these
requirements.

Nonperishable
foods, water and clothing

Bed and
Bedding (lounge chair, cot,
sleeping bag)

Personal
hygiene items

Medications
in labeled prescription
bottles

A

list of their
medical conditions, and
contact name(s) and numbers
for doctor(s)

Review with
caretaker that they must remain with the
client at all times and/or arrange for
their own relief. Failure to
do so will be considered abandonment and
they will be reported to Adult
Protective Services. Have the
client and their caretaker sign the
Memorandum of Understanding (MOU) for
the Special Medical Needs Shelter (Appendix
E).

Refer to Special Medical
Needs Shelter designated area.

2.

Walk-ins:

Complete
a Special Medical Needs Shelter Initial
Triage Assignment (Appendix
F). Review for appropriate placement
into the Special Medical Needs Shelter.
Refer to Shelter Policies and/or Special
Medical Needs Shelters Levels of Care (Appendix
A) for additional assistance in
triaging clients. REMEMBER, PREFERENCE
IS GIVEN TO Fictitious COUNTY RESIDENTS,
OTHERS ARE ACCEPTED ONLY IF SPACE IS
AVAILABLE.

If the
client can be accommodated in the
General Shelter direct accordingly.

If
client qualifies for the Special Medical
Needs Shelter - Complete the Special
Needs Registration Form (Appendix
D).

Ensure
that there is a caretaker with the
client.

If client
meets the criteria for placement in the
Special Medical Needs Shelter, have the
client arid their caretaker sign the MOU
for Special Medical Needs Sheltering (Appendix
E) direct to the Special Medical
Needs Shelter area and orient
accordingly.

3.

Denial of
Shelter:

A potential
client may be denied shelter because:

His/her
medical condition exceeds the scope of
the Special Medical Needs Shelter;

The
Special Medical Needs Shelter exceeds
manageable capacity; refer the client
and for caregiver to the Shelter Manager
for possible referrals to other
facilities.

Roles and
Responsibilities of Special Medical Needs
Shelter Staff:

1.

Set-up of
Shelter

Fictitious County Emergency Management
will be responsible for set up of
generators and emergency lighting and
other equipment for the Special Medical
Needs Shelter.

Fictitious County Emergency Management
will station one (1) EMS ambulance and 2
EMTs at the Special Medical Needs
Shelter.

DSS and
Health Department Staff will jointly set
up triage and bedding areas in the
Special Medical Needs Shelter.

Fictitious County Schools will provide
such services as required in a
Memorandum of Understanding (MOU between
Fictitious County and the School Board).

2.

Ongoing Actions

Set up
"Nurses Station" where persons in the
center can come for medical/health
assistance (log all activity).

Provide
general oversight and low level
monitoring of medical or health needs.

Provide
First Aid Services.

Keep
clients as calm as possible.

Monitor
client conditions for changes and
immediately notify DSS of need to access
EMS for transport to ER.

Assist
in keeping areas clean and free of
trash. This will help ensure safety and
clear paths to restrooms and to provide
ease of making rounds.

Assure
caregivers are available to Special
Medical Needs Shelter client at all
times.

Provide
emergency assistance if needed.

Maintain
universal precautions and infection
control.

Keep
client aware of time and inquire if
assistance is needed. Provide
diversionary activities, conversation,
etc.

Make
rounds watching for signs of agitation,
depression, confusion, etc. and
responding to alleviate potential
problems.

Appendix DShelter Registration Form(to print this form, copy and
paste to a word processor or click
here for a
PDF version of the form below)

DISASTER
SHELTER REGISTRATION

Family Last Name

Shelter Location

Names

Age

Medical Problem

Referred to
Nurse

Shelter
Telephone
No.
Date of Arrival

Man

Pre-disaster
Address and
Telephone No.

Woman (include
maiden name)

Children in Home

I _____do
_____do not,
authorize
release of the
above
information
concerning my
whereabouts or
general
condition.

________________________________________

Signature

Date Left
Shelter
_______________________

Time Left
Shelter
______________________

Family Member
not in Shelter
(Location if
known)

Post Disaster
Address and
Telephone
Number:

Similar to: American Red
Cross Form 5972 (5-79)

Appendix E
Memorandum of Understanding - Caregivers
(to print this form, copy and paste to a
word processor or click here
for a MS Word version of the form)

SPECIAL
MEDICAL NEEDS SHELTER
MEMORANDUM OF UNDERSTANDING
BETWEEN SPECIAL
MEDICAL NEEDS SHELTER
CLIENTS/THEIR CARETAKERS
AND Fictitious COUNTY

IMPORTANT
NOTICE AND STATEMENT OF
UNDERSTANDING

I understand
that:

Special Medical Needs
Shelters in Fictitious
County are provided as a
Refuge of Last Resort for
individuals with certain
special care needs who
cannot be accommodated or
provided for in a general
population shelter or who
have not made other
arrangements with relatives,
friends, and/!or available
licensed health care or
special home care
facilities.

The Special Medical Needs
Shelter should be considered
an option of last resort and
is intended to maintain the
current health, safety, and
well being of a client who
IS not acutely ill, to the
extent possible for a short
period of time.

Special Medical Needs
Shelters are not equipped as
a medical care facility.
They are not a hospital, a
nursing home/restorative
care center.

There is NO doctor, NO acute
care nurses, NO specialty
care nurses, and NO private
duty personnel at the
shelter.

A caretaker MUST accompany
shelter occupants and stay
with the client while in the
Special Medical Needs
Shelter at all times and/or
make arrangements for their
own relief. Failure to do so
will be viewed as
abandonment and the
caretaker will be reported
to Adult Protective
Services.

A public health nurse will
be onsite at all times and
will be providing general
oversight and low level
monitoring. Nurses in the
shelter are NOT permitted to
provide homecare/activities
of daily living or
administration of
medications/injections, or
any medical and/or treatment
procedures.

Clients and their caretakers
are expected to bring to the
shelter all supplies
including food, water,
clothing, personal hygiene
items, and bedding,
medications, specialty items
such as diapers, feminine
supplies, wheelchairs,
oxygen, compressors, backup
tanks of oxygen, dressing
supplies, etc., that they
will need for at least a 72
hour period. The shelter is
not responsible for
providing supplies.

Establish
contact
with
facility
representatives
and
activate
the
building
when
ready.
IF
clients
are
waiting
the
facility
may
have
to
be
partially
activated
immediately.

Using
the
Statement
of
Agreement
and
Facility
Survey,
if
they
already
exist,
meet
the
facility
representative
for
a
pre-occupancy
inspection.
Negotiate
and
sign
a
Facility
Agreement.
Conduct
pre-occupancy
inspection
using
Self-Inspection
Worksheet
Off-premises
Liability
Checklist,
and
assess
the
general
condition
of
the
facility,
citing
pre-existing
damage.

Establish
and
meet
regularly
with
the
shelter
advisory
committee,
and
ensure
that
the
physical
and
mental
needs
of
clients
are
being
met.
Develop
plans
to
meet
these
needs
and
request
assistance
if
necessary.

Ensure
that
shelter
residents
are
receiving
updated
information
about
the
disaster,
the
recovery
process,
and
all
of
the
resources
available
to
them.

Forward
a
copy
of
new
registrations
to
Disaster
Welfare
Inquiry
and
Family
Service
units
daily.

Establish
standard
shift
schedules
for
staff,
usually
for
9 to
13
hours.

Conduct
staff
meetings.
Include
updates
on
disaster
response
and
shelter
operations,
directions
and
advice
from
disaster
headquarters,
and
status
of
problems
and
resolutions.
Identify
needs
for
clients,
staff,
supplies,
and
systems.
Address
rumors.

Monitor
disaster
response
efforts,
and
plan
for
the
closing
of
the
shelter.

Ensure
that
the
proper
systems
are
in
place
to
track
expenditures,
bills
and
invoices,
materials,
and
local
volunteer
records.

Develop
plans
for
maintaining
the
shelter
until
closing
is
possible,
including
staffing
and
supply
needs.

Routinely
inspect
the
safety
and
sanitation
of
the
facility,
including
the
kitchen,
dormitories,
bathrooms,
exterior
and
registration
area
and
ensure
that
health
standards
and
clients'
needs
are
being
met.

Meet
regularly
with
the
facility
representative
to
share
concerns
and
resolve
potential
problems.

Work
with
the
clients
and
feeding
supervisor
to
ensure
the
appropriate
menus
are
being
planned
that
reflect
the
preferences
of
the
shelter
population.

Closing
Actions

Coordinate
plans
to
close
the
shelter
with
your
supervisor
and
community
well
in
advance
of
the
actual
closing.

Coordinate
with
Family
Service
to
ensure
timely
and
appropriate
placement
of
all
remaining
shelter
occupants.

Communicate
to
any
remaining
shelter
residents
the
plan
for
closing
the
shelter.
Encourage
individuals
who
have
not
already
contacted
Family
Service
to
do
so.

Consult
with
your
supervisor
about
the
disposition
of
all
Red
Cross
and
USDA
food
supplies.

Ensure
Logistics
staff
take
the
following
actions:

Complete the inventory of all supplies owned by the facility that were used in the shelter, and forward this to your supervisor.

Return all rented or borrowed equipment to owners. Send your supervisor signed receipts for such equipment.

Arrange for the cleaning of the facility and have it returned to the pre-occupancy condition or as close to the pre-occupancy condition as possible.

Return all Red Cross supplies and equipment to the chapter/department/agency or central storage facility. Submit to your supervisor a list of items returned.

Forward all pending financial commitments to the supervisor for payment. Ask suppliers to send final bills to your supervisor.

Consult
with
the
supervisor
about
transfer
or
release
of
staff.

Remove
all
Red
Cross
ID
materials
from
the
facility.

Prepare
a
thank-you
list
of
other
voluntary
organizations,
vendors,
and
staff
to
be
thanked
or
recognized.

Forward
all
Mass
Care
shelter
files
to
the
chapter/department/agency.

Forward
all
volunteer
lists
to
the
Local
Disaster
Volunteer
function
or
the
chapter/department/agency
for
recognition
and
appreciation
letters.

Prepare
a
narrative
report
on
the
shelter
operation
and
submit
it
to
your
supervisor.
Include
the
shelter
location
and
dates
of
operation,
summary
of
services
provided,
problems
and
recommendations.

Attachment 4
STATEMENT OF UNDERSTANDING BETWEEN THE
FICTITIOUS CHAPTER OF THE AMERICAN RED CROSS
AND THE
FICTITIOUS COUNTY OFFICE OF EMERGENCY
MANAGEMENT

PURPOSE

The purpose of this statement of
understanding is to provide for the
cooperation and coordination between the
County of Fictitious and its agencies and
the Fictitious Chapter of the American Red
Cross, in carrying out their assigned
responsibilities in the event of natural of
man-made disasters or terrorism attack.

General Statutes of North Carolina Chapter
166A, North Carolina Management Act.

Fictitious County Multi-Hazard Emergency
Operations Plan

The Fictitious Chapter of the American Red
Cross

The American Red Cross is an instrumentality
of the United States Government, with a
Congressional Charter, codified at 36 U.S.C.,
Section 1 et. seq., under which it is
charged to “…carry on a system of relief in
time of peace and apply the same in
mitigating the suffering caused by
pestilence, famine, fire, floods and other
great national calamities…” This role has
been restated in the Disaster Relief Act of
1974 (P.L. 93-288), which says “…nothing
contained in this act shall limit, or in any
way affect the responsibilities of the
American Red Cross under the Act of January
5, 1905.

SCOPE OF FICTITIOUS CHAPTER OF THE AMERICAN
RED CROSS ACTIVITIES

Natural Disasters

The magnitude of a disaster may be such that
it simultaneously affects tens of thousands
of people in several states or it may bring
suffering and anguish to just a few persons
in one apartment building or group of
houses. Regardless of the extent of the
disaster, it is the responsibility of the
National American Red Cross to help meet the
human needs that the disaster has
caused. These needs may include food,
clothing, shelter aid and other basic
elements for comfort and survival. As an
instrumentality of the National American Red
Cross, the Fictitious Chapter would conform
to these standards on the County level.

The Fictitious Chapter of the American Red
Cross also helps disaster victims needing
long-term recovery assistance by advising
and counseling them on the availability of
resources, so that they can resume living in
keeping with acceptable standards of health,
safety and human dignity. Such resources
include those of their own family, as well
as federal, state and local agencies, both
public and private. If there are no other
resources available, the Fictitious Chapter
of the American Red Cross may provide direct
additional assistance to enable the victims
to re-establish themselves.

Red Cross assistance to disaster victims is
not dependent upon a Presidential or other
federal, state or local disaster declaration
but is provided regardless of the size of
the catastrophe or disaster incident.

In carrying out its responsibilities to
provide for mass care in peacetime
disasters, including precautionary
evacuations and hazardous material
emergencies / terrorism attacks, the
American Red Cross will operate appropriate
shelters facilities and arrange for mass
feeding and other appropriate support. In
doing so, the Red Cross will pay related
costs only when such activities are under
the administrative control of or authorized
by the American Red Cross, or when prior
written agreements have been made for some
other organization to provide emergency
services on behalf of the Red Cross.

American Red Cross’ disaster
responsibilities are nationwide. Therefore,
when the American Red Cross Chapter is
unable to meet the needs of the disaster
victims, the resources of the total
organization are made available.

The American Red Cross provides blood and
blood products and handles welfare inquiries
from anxious relatives outside the disaster
area.

The Fictitious Chapter of the American Red
Cross may conduct an appeal for voluntary
contributions of funds at the time of the
disaster.

In disasters with company or owner liability
implications, the customary emergency
services will be extended on either a mass
care basis or to individuals and families if
such help is not or cannot be provided
immediately by the owner of the property
involved, [after such unpredictable
catastrophes as collapse of private dams,
fires in motels, theaters, night clubs,
pleasure boats and etc].

HAZARDOUS MATERIAL EMERGENCIES

In case of Hazardous Material emergencies,
which have company or owner liability
implications, the American Red Cross will
conduct shelter and feeding operations in
centers and facilities designated in advance
by the County Office of Emergency
Management, under arrangements worked out
among the County Office of Emergency
Management, the American Red Cross and
officials or owners of the buildings.

CIVIL DISORDERS

Where there is suffering and want resulting
from civil disorders and fundamental human
needs are not met, the Fictitious Chapter of
the American Red Cross will participate in
community action to supplement the efforts
of the responsible civil authorities in
extending emergency services and relief to
the victims of such disturbances.

OTHER EMERGENCY SITUATIONS

Situations caused by economic, political and
social maladjustment including the usual
hazards of industry and agriculture, are not
usually considered to be within the American
Red Cross responsibility for disaster
preparedness and relief. There may be other
kinds of emergencies involving large numbers
of people; or problems related to energy
outages, costs or shortages that create
evident human needs or in which public
officials request Red Cross assistance.

TERRORISM-CAUSED SITUATION

In terrorism-caused situations, the
Fictitious Chapter of the American Red Cross
will use its facilities and personnel to
support and assist mass care and emergency
operations of the County Office of Emergency
Management, to the extent the Red Cross
considers possible, while carrying out its
other essential responsibilities and
assignments.

NATIONAL EMERGENCY REPATRIATION

During the emergency repatriation of United
States Citizens and dependents evacuated
from foreign countries during national
emergencies, the Fictitious Chapter will at
ports of entry designated in Fictitious
County (if any), provide mass feeding, first
aid and mass care including Disaster Health
Services.

COORDINATION AND COOPERATION

In the discharge of its responsibilities,
the Fictitious County Chapter of the
American Red Cross, recognizes the
responsibility of the Fictitious County
Office of Emergency Management in disasters
and will coordinate its activities as
required. This is essential when a state of
emergency is declared by the Governor or the
President has declared an emergency or major
disaster.

The Fictitious County Chapter of the
American Red Cross will keep the Emergency
Management Coordinator or his / her designee
advised of actions taken and will keep a
continuing liaison with the Fictitious
County Office of Emergency Management to
ensure effective assistance to all disaster
victims.

Responsibility for coordinating the services
or other voluntary agencies or groups during
and after a major disaster will be
undertaken by the American Red Cross upon a
request from the Fictitious County Office of
Emergency Management and with the consent of
such agencies.

The Fictitious County Chapter of the
American Red Cross agrees that, in an
emergency, at the request of the Fictitious
County Office of Emergency Management, the
Red Cross liaison person will be provided at
the Fictitious County Emergency Operation
Center.

PLANNING AND IMPLEMENTATION

Cooperative arrangements for planning,
exchange of information and continuing
liaison regarding preparedness and disaster
operations will be developed and maintained
by the Fictitious County Office of Emergency
Management and the American Red Cross.